1. health and fitness
2. disease
3. epilepsy

MANAGING CHILDREN
WITH EPILEPSY
SCHOOL NURSE GUIDE
ACKNOWLEDGEMENTS
TO THOSE WHO HAVE CONTRIBUTED TO THE NOTEBOOK
Children’s Hospital of Orange County
Melodie Balsbaugh, RN
Sue Nagel, RN
Giana Nguyen, CHOC Institutes
Fullerton School District
Jane Bockhacker, RN
Orange Unified School District
Andrea Bautista, RN
Martha Boughen, RN
Karen Hanson, RN
TABLE OF CONTENTS
I.
EPILEPSY
ƒ What is epilepsy?
ƒ Facts about epilepsy
ƒ Basic neuroanatomy overview
ƒ Classification of epileptic seizures
ƒ Diagnostic Tests
II.
TREATMENT
ƒ Medications
ƒ Vagus Nerve Stimulation
ƒ Ketogenic Diet
ƒ Surgery
III.
SAFETY
ƒ First Aid
IV.
SPECIAL CONCERNS
ƒ MedicAlert
ƒ Helmets
ƒ Driving
ƒ Employment and the law
V.
EPILEPSY AT SCHOOL
ƒ School epilepsy assessment tool
ƒ Seizure record
ƒ Teaching children about epilepsy lesson plan
ƒ Creating your own individualized health care plan
VI.
RESOURCES/SUPPORT GROUPS
VII. ACCESS TO HEALTHCARE
ƒ CHOC Epilepsy Center After-Hours Care
ƒ After Hours Health Care Advice
ƒ Healthy Families
ƒ California Kids
ƒ MediCal
ƒ CHOC Clinics
ƒ Healthy Tomorrows
VIII. REFERENCES
EPILEPSY
WHAT IS EPILEPSY?
Epilepsy is a neurological disorder. The brain contains millions of nerve
cells called neurons that send electrical charges to each other. A seizure
occurs when there is a sudden and brief excess surge of electrical activity in
the brain between nerve cells. This results in an alteration in sensation,
behavior, and consciousness.
Seizures may be caused by developmental problems before birth, trauma at
birth, head injury, tumor, structural problems, vascular problems (i.e. stroke,
abnormal blood vessels), metabolic conditions (i.e. low blood sugar, low
calcium), infections (i.e. meningitis, encephalitis) and idiopathic causes.
Children who have idiopathic seizures are most likely to respond to
medications and outgrow seizures.
FACTS ABOUT EPILEPSY
ƒ About 1.5 million people in America have epilepsy
ƒ 25 percent of new cases of epilepsy occur in children 14 years and
younger
ƒ Epilepsy refers to more than 20 different types of seizure activity
ƒ The cause is unknown in 70 percent of all cases of epilepsy
ƒ Epilepsy is a physical condition. It is not a mental illness or a sign of low
intelligence
ƒ Children with seizure disorders can live a normal, active life, play sports
and enjoy life
BASIC NEUROANATOMY OVERVIEW
GENERAL FUNCTIONS OF THE CEREBRAL CORTEX
ACCORDING TO LOBES
Frontal lobes: Responsible for high level cognitive function, personality,
memory, anxiety, alertness, and awareness; frontal and temporal lobes are
the most epileptogenic
Temporal Lobe: Responsible for receptive and expressive speech,
epileptogenic
Parietal Lobe: Responsible for bringing all perception together; called the
association cortex, rarely the source of seizures
Occipital Lobe: Responsible for vision, uncommon origin of seizures
CLASSIFICATION OF EPILEPTIC SEIZURES
PRIMARY GENERALIZED SEIZURES
ƒ Absence Seizures (Formerly called petit mal)
¾ Typical
¾ Atypical
ƒ Myoclonic
ƒ Atonic
ƒ Clonic
ƒ Tonic
Brief episodes of staring, blinking, unaware of
surroundings; usually lasts less than 10 seconds but may
last up to 20 seconds
Staring spells lasting between 5 to 30 seconds,
eye blinking or slight jerking movement of the lips may
occur; partial reduction in responsiveness
Brief jerks of a muscle or group of muscles; usually
involving the neck, shoulders, and upper arms
Sudden loss of muscle strength, eyelids may droop, head
may nod, objects may be dropped, or the child may fall to
the ground; usually lasts less than 15 seconds, injury is
common; child typically needs to wear a helmet
Rhythmic jerking movements of the arms and legs, may
be generalized
Sudden stiffening movements of the body, arms, or legs
involving both sides of the body; usually last less than
20 seconds
ƒ Tonic-Clonic (Formerly called grand mal)
Convulsive seizures, body briefly stiffens followed by a
jerking motion of the arms and legs; loss of
consciousness and falls frequently occur, excessive saliva
production may be present, possible loss of bowel and
bladder control; usually lasts a couple of minutes, the
child is often tired or confused after the seizure and may
want to go to sleep
PARTIAL SEIZURES (SEIZURES ORIGINATING IN SPECIFIC PARTS
OF THE BRAIN)
ƒ Simple Partial (Focal seizures)
¾ With motor symptoms
¾ With somatosensory
¾ With autonomic symptoms
¾ With psychic symptoms
ƒ Complex partial seizures
Consciousness not impaired
Jerking and stiffening
Touch, smell, hearing, taste, and sight
symptoms
Heart rate change, internal sensations
Dreamy state
Consciousness impaired
Movements of the mouth and face
(e.g., lip smacking, chewing, and
swallowing movements), the hands
and arms (e.g., fumbling, picking, and
tapping movements), vocalizations
(e.g., grunts or repetition of words or
phrases)
DIAGNOSTIC TESTS
The accurate diagnosis of seizure disorders is crucial in tailoring an optimal
treatment plan. The following is a list of diagnostic tests that may be
utilized:
ƒ Electroencephalogram (EEG) – This is a machine used to measure brain
waves. It helps the neurologist identify the location, severity and type of
seizure disorder. In many instances, however, a person with epilepsy can
have an EEG done with no sign of seizure activity detected. This may
occur when no activity was happening at the time of the test, or the
seizure activity was so deep within the brain that the EEG machine was
unable to detect it.
ƒ Computed Tomography Scan (CT Scan) – This test helps identify blood
clots, cysts, brain tumors, scar tissue or other problems that can cause
seizures. The computer-generated view of the brain provides detail of the
brain’s structure, section by section.
ƒ Magnetic Resonance Imaging (MRI) – This test is used to identify
structure and abnormalities within the brain. This technique utilizes a
magnet rather than x-rays to generate a detailed picture of the brain. The
procedure takes longer than a CT scan and it is painless.
ƒ Outpatient/Inpatient Long Term EEG Monitoring – During this
procedure a patient is video taped for a period of time while he/she is
connected to electrodes to monitor brain activity. This test is utilized to
confirm and diagnosis a seizure disorder. In some groups of patients
with seizure-type movements, their condition is not related to epilepsy
and that is why they are not responding to the different epilepsy-based
treatment options. This test enables the physician to look at the patients
movements and correlate this with the results on the EEG, thus allowing
the doctor to confirm or reject a seizure diagnosis. Long term EEG
monitoring is also a critical component of the surgical treatment of
epilepsy to pinpoint the area of the brain responsible for the seizures.
TREATMENT
MEDICATIONS
See insert
VAGUS NERVE STIMULATION (VNS)
The VNS is a medical device that is surgically implanted under the skin on
the chest wall. Two small wires from the device wrap around the vagus
nerve. The stimulator provides intermittent, mild pulses of electrical energy
through the vagus nerve to the brain. When a student senses the impending
onset of a seizure, the student or school staff can activate the device through
a hand-held magnet to deliver an additional dose of stimulation. The VNS is
utilized in those students who fail to obtain seizure control with antiepileptic
medications.
KETOGENIC DIET
The ketogenic diet consists of mostly fats with little or no carbohydrates and
a minimal amount of protein. A student on the ketogenic diet is followed
closely by a physician and a dietitian. The diet is labor intensive requiring
careful weighing and measuring of food and strict compliance. When the
body metabolizes its own fats and proteins, a chemical substance called
ketone bodies is produced, thus the name ketogenic diet. This diet is most
often utilized in children 18 months to 9 years of age whose seizure disorder
is not controlled through the use of antiepileptic medications.
SURGERY
When medication is not effective surgery is considered as an option. A
thorough evaluation will determine if the patient is a candidate for surgery.
The primary objective of most epilepsy surgical procedures is to accurately
localize and then completely remove the region of the brain responsible for
the seizure without causing cognitive or neurological deficit.
Surgical options include:
ƒ Lesionectomy – If the recurrent seizures are found to be caused by small
lesions such as cavernous angiomas, lowgrade astrocytomas, cortical
dysplasias and areas of focal atrophy, they may be successfully removed.
Lesionectomy is associated with excellent results and success rates are
generally better than those associated with surgery performed in patients
without discrete lesions.
ƒ Temporal resection – This procedure removes part of the temporal lobe
of the brain where the epilepsy seizures originate. If patient selection is
appropriate, surgery in the temporal lobe offers good to excellent results
in 75% to 85% of the cases.
ƒ Extra-Temporal resection – This is less commonly performed and the
success rate is lower than temporal lobes resections.
ƒ Intracranial Monitoring – Sometimes the seizure focus cannot be
determined. In this instance, diagnostic surgical options may be
recommended. This involves implanting electrodes into the brain,
providing more precise EEG information due to the closer proximity to
the seizure focus area.
ƒ Hemispherectomy – This procedure is reserved for patients with severe
epilepsy with widespread independent epileptic discharges in one
hemisphere, often extending to the normal hemisphere. This procedure
involves removing most or all of one of the brain’s hemispheres. This
procedure has grown in sophistication over the years and has yielded
impressive results. But again, it is only reserved for a very select group of
patients.
ƒ Corpus Callostomy – This surgery has been offered as an alternative to
hemispherectomy in epileptic patients, but is not as effective as
hemispherectomy. This surgery involves removing the corpus callosum
of the brain.
SAFETY
FIRST AID
ƒ STANDARD FIRST AID
¾ Stay calm
¾ Protect student from injury but do not restrain movements
¾ Help the student lie down and turn on one side if possible
¾ Loosen all tight clothing
¾ Do not put anything in the mouth
¾ Do not give medicines or fluids until the child is completely awake
¾ Stay with the student until he or she is fully alert and oriented
¾ Provide reassurance and support after the seizure episode
¾ CPR should not be given during a seizure
¾ Record the duration and describe the seizure on the epilepsy log
¾ Report the seizure to the appropriate person: parents, school nurse,
and/or administrator
ƒ EMERGENCY FIRST AID
¾ Call 911 if:
• First known seizure
• Seizure lasts more than 5 minutes
• Another seizure begins soon after the first
• The student stops breathing or has difficulty breathing after the
seizure
• Student cannot be awakened after the seizure
• There are specific orders to call 911 from the physician
• The recovery is different than usual
• The need for assistance is uncertain
SPECIAL CONCERNS
MEDICALERT
A person with epilepsy should wear a medical-alert bracelet or necklace that
gives critical information in order to medically treat a student correctly. The
MedicAlert emblem is engraved with important information such as:
diagnosis, medications, telephone numbers of the doctor, and the person to
call in case of an emergency. It can help avoid costly medical bills and
unnecessary actions. The MedicAlert organization may be contacted at
www.medicalert.org or (888) 633-4298. See insert provided
HELMETS
Some students with epilepsy need to wear a helmet to provide protection
from falling due to seizures. Bicycle helmets do not provide the best
protection for students with seizures. A helmet should be chosen by
observation of seizure behaviors. A student who tends to fall forward during
seizures will need a helmet with a face guard, face bar, or visor. A student
that falls backward will need occipital protection. The helmet is most
effective if it is secure on the head with a snug chin strap. Hockey helmets
made by Cooper give good protection. Helmets are available through
sporting good stores, medical supply companies, and the rehabilitation
departments of some hospitals.
DRIVING
Medication compliance is crucial, especially for teenagers desiring to get
their driving licenses. Typically, students must be seizure free for one year
before they will be granted a driving license. In California a “mandatory
reporting law” requires physicians to report people who have epilepsy to the
DMV and their frequency of seizures. A student with epilepsy who has a
motor vehicle accident may be civilly or criminally liable. In addition,
doctors may be held responsible if they failed to notify the DMV of the
medical condition.
EMPLOYMENT AND THE LAW
Gainful employment provides a powerful source of self esteem and can
increase quality of life. Employers may discriminate against those with
epilepsy for a variety of reasons. The Americans with Disabilities Act
(ADA) passed in 1990 to help protect people with certain disabilities from
discrimination when applying for a job or while on the job. Students with
epilepsy who are considering a part time job should be encouraged to
contact Epilepsy Foundation (www.efa.org). They can provide valuable
information to those with epilepsy.
EPILEPSY AT SCHOOL
SCHOOL EPILEPSY ASSESSMENT TOOL
NAME: _________________________________ DOB: _________ AGE: ________
SCHOOL: ________________________________________________
Does student have seizures?
No referral necessary
No
Yes
Has student been medically evaluated for
seizures?
No
Refer to PCP and/or child
neurologist
Yes
Is student on antiepileptic medications?
No
Refer to PCP and/or child
neurologist
Yes
Are seizures controlled?
(<1 seizure per month, rare seizures at school)
No
Refer to center specializing in
epilepsy care for children
Yes
Are antiepileptic medications affecting
quality of life and/or school performance?
Yes
Refer to center specializing in
epilepsy care for children
No
Is student receiving regular follow-up with
PCP and/or child neurologist?
Yes
No referral necessary
No
Refer to PCP and/or child
neurologist
SEIZURE RECORD
The seizure record form is a valuable tool that can be utilized to keep the
school nurse, parents and the student’s physician informed about the seizure
activity of a student. The form may be kept in the school office or in the
teacher’s room which ever is most appropriate. Periodically the form should
be sent or mailed home so that the parents are advised of their child’s status.
NAME:
SCHOOL:
SEIZURE RECORD
Date
Time Started
Behavior Before
Seizure/Aura
First Body Part
Involved
Total Body Parts
Involved
Time Ended
Recovery Time
Recovery Behaviors
TEACHING CHILDREN ABOUT EPILEPSY
LESSON PLAN
This lesson plan can be adapted for use at any grade level.
When a student has a seizure at school it can be traumatic for everyone
involved. Those who witness the seizure can become frightened by the
sudden onset of a seizure and the dramatic behavior it causes. Often people
do not know how to respond and this creates anxiety, especially in children.
Thus a child with epilepsy can feel ostracized, embarrassed, and ashamed.
A teacher or a school nurse who can provide age appropriate information
can play a significant role by decreasing the fears of the classmates and
increasing acceptance of a child who has epilepsy.
Objectives
ƒ Students will gain a basic understanding of the nature of epilepsy
ƒ Students will respond appropriately to a seizure episode
ƒ Students will demonstrate an acceptance towards the child with
epilepsy
Materials needed
Doll for demonstration purposes, paper (or response journals) and pencils
Anticipatory Set
Who has never had a hiccup or a sneeze? We all have sneezed and
hiccupped. We really don’t have much control over when we hiccup or
sneeze. They just happen. That’s the way it is with seizures.
Modeling
¾ Before a seizure occurs:
If the student in the class has frequent seizures, it would probably be best to
introduce this lesson early to prepare the classmates for an episode. Obtain
permission from the parents first and invite them to attend and even
participate with you. Decide beforehand with the parent and the epileptic
child whether or not to include him/her in the class discussion.
Do you know anyone with epilepsy? Wait for responses.
Sometimes ___________’s brain does not work right and he has something
called a seizure. His brain is sending mixed-up messages to his body and his
body parts are not working right.
It’s important to remember that you cannot catch epilepsy from someone.
Medication is given to help control the seizure activity.
Discuss types of behavior the child typically would display during a seizure.
You may want to demonstrate them.
Determine and discuss age appropriate ways that classmates would be able
to assist in this type of a situation.
STANDARD FIRST AID
ƒ Stay calm
ƒ Have one student notify a teacher/adult immediately and
another student stay with victim
ƒ Protect the student from injury but do not restrain movements
ƒ Help the student lie down and turn on one side
ƒ Loosen all tight clothing
ƒ Do not put anything in the mouth
ƒ Do not give anything to drink
ƒ Stay with the student until he is fully alert and oriented
Ask students: Have you ever felt embarrassed about anything? What do you
think it would feel like to have a seizure? What could you do to make that
person feel comfortable?
¾ After a seizure occurs:
Discuss with students:
ƒ What happened?
ƒ What did you see?
ƒ How did you feel?
ƒ May want to include an age appropriate science lesson on the
activity of the brain
Guided Practice
ƒ Students will state or journal a basic understanding of why seizures
occur
ƒ Students will demonstrate first aid techniques that are appropriate
ƒ Students will demonstrate ways to comfort a student after a seizure
Independent Practice
Have students break up into groups of three to demonstrate first aid and
comfort to a seizure victim. Each student will perform one of the three
roles: Victim, helper, and evaluator.
Evaluation
Watch interactions between classmates and student with seizure disorder.
After a seizure episode, teacher will evaluate the effectiveness of students’
response and re-teach accordingly.
At the end of the lesson ask: What is a seizure? How did you feel when you
were the person who had the seizure? How did you feel when you were the
helper? How can we make ________ feel comfortable and accepted?
CREATING YOUR OWN INDIVIDUALIZED HEALTH CARE PLAN
The Orange County Department of Education Seizure History form can be
used to develop a care plan. The following health care plans are utilized by
school nurses in the Orange County area. These can be modified to fit the
specific needs of your student.
ORANGE COUNTY DEPARTMENT OF EDUCATION
SEIZURE HISTORY
Student __________________________________
School __________________________________
Date of Birth ________________________________
Date Completed _____________________________
School records indicate your child has a seizure disorder. The school is requesting the following
information so we can better assist your child should a seizure occur at school. Immediate care may be of
an emergency nature.
Please answer the following questions and return to school as soon as possible:
1. Seizure type _________________________________________________________________________
2. Describe the seizures __________________________________________________________________
____________________________________________________________________________________
3. Average length of time seizure lasts _______________________________________________________
4. How often seizures occur _______________________________________________________________
5. Describe student’s behavior following a seizure _____________________________________________
6. What will trigger a seizure? _____________________________________________________________
7. List any warning signs before the seizure ___________________________________________________
8. Please list any medications your child receives ______________________________________________
Name of medication _________________________________ Dose/Time given ______________
Name of medication _________________________________ Dose/Time given ______________
Name of medication _________________________________ Dose/Time given ______________
Name of medication _________________________________ Dose/Time given ______________
9. Physician’s Name __________________________________ Telephone # ________________________
10. Additional Comments: ________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
__________________________________________
Parent Signature
Date
_________________________________________
Principal Signature
Date
__________________________________________
School Nurse Signature
Date
_________________________________________
Teacher Signature
Date
NOTE: Parents are responsible to notify school nurse if medication/seizure information changes.
Sample 1: Care Plan
ABSENCE
SEIZURES
Description: Brief lapses of consciousness (1-4 seconds, like
daydreaming) that begin and end abruptly.
First Aid
1. Reassure, if needed.
2. Repeat any missed information.
3. If a first episode, notify parents/family.
PARTIAL
SEIZURES
Description: Consciousness unimpaired; uncontrollable changes in
mood, sensation, and/or movement (such as twitching of a body
part).
First Aid
1. Give reassurance/emotional support as needed.
2. If a first episode, notify parents/family.
COMPLEX
PARTIAL
SEIZURES
Description: Impaired consciousness accompanied by confusion
and uncontrollable automatic movements (such as wandering about,
touching things, etc.). May strike out if abruptly restrained. Lack
of responsiveness may be misinterpreted as a behavior problem.
First Aid
1. Stay calm and reassure other students.
2. Protect from harm/hazards.
• Direct away from hazards.
• Do not grab roughly or restrain.
• Do not expect verbal instructions to be obeyed.
3. Stay with person until fully recovered.
4. Help reorient to surroundings.
5. If a first episode, notify parents/family.
Sample 1: Care Plan
GENERAL
TONIC –
CLONIC
SEIZURES
(Grand Mal)
Description: Loss of consciousness accompanied by falling,
stiffening and jerking movements (average time is 1-2 minutes).
Breathing is shallow or absent; skin possibly pale or bluish.
First Aid
1. Remove nearby objects/hazards
- and If in a chair, ease to floor (as possible).
2. Position (as possible) to minimize harm.
3. Do not restrain. Do not put anything in mouth.
4. After seizure, position on side and open airway (prevents
airway obstruction from drooling and possible vomiting).
5. Reassure victim (may have wet pants/BM)
- and Reorient to surroundings (may be alert but groggy).
6. If needed, provide period of rest (allows for recovery of clarity
and consciousness).
7. Educate others.
• Help everyone present to understand, to be a positive
support system, and to be able to provide first aid.
• In classroom and with parent permission, involve affected
students as an expert resource.
8. Notify parent or other adult.
• Parent should be sure child is taking medication regularly.
• An adult should be seen by an MD to assist in seizure
control.
9. Get medical help if:
• Injury occurs
• No history of seizures
• No return of breathing
• Seizure lasts more than five minutes
• Repeated seizures, especially without regaining
consciousness
• Patient or parent requests care
• Patient is pregnant or has diabetes
Sample 2: Care Plan
School: ___________________________________
Authorization date
Physician: _________________
Parent: ____________________
Student: __________________________________
Seizure Care
I.
PERSONNEL
A.
School Nurse
The school nurse is the direct and indirect procedural supervisor responsible for training and monitoring
involved staff.
B.
Designated school personnel under direct or indirect supervision by the school nurse.
II.
GENERAL INFORMATION
A.
A seizure is a brief disruptive discharge of electrical impulses in the brain. It can affect the whole brain and
disrupt consciousness, or just part of the brain, in which case consciousness may or may not be affected.
B.
Signs and symptoms vary according to the type of seizure a person experiences. Certain parts of the brain
control different body functions. The function of the body which is affected is related to the part of the
brain involved in the seizure.
C.
The International Classification of Seizures identifies two major groupings of seizures and over thirty
different types of seizures. For further information, refer to The Epilepsy Society’s chart on seizures.
D.
Status Epilepticus can occur when there is a series of seizures without complete recovery in between or a
single seizure lasting more than thirty minutes. During a prolonged convulsive seizure, depletion of
oxygen, blood flow, and nutrients to the brain occurs. Each child’s physician needs to define what would
represent a status seizure for a particular child.
E.
Regular use of medication controls seizures in the majority of cases. A separate medication form must be
completed for medication administration at school. Rectal medication may be ordered in case of a status
seizure.
F.
Parent/care-provider must complete the seizure history form as part of this Specialized Physical Health
Care Service (SPHCS).
G.
Procedure will be fully discussed with parent/care-provider/guardian. IEP face sheet should indicate that
SPHCS are required for seizure care. A copy of this procedure is to be attached to the IEP.
H.
If medication is required, “Parent/Guardian and Physician Request for Medication” must be completed.
I.
If “Parent Consent for Administration of SPHCS” and/or “Physician’s Order for Treatment” do not
accompany this SPHCS then standard treatment for seizure will be given according to the American
Epilepsy Society’s guidelines.
III.
GUIDELINES
Purpose
1. Provide first aid for seizure activity.
2. Parent/care-provider should always be notified of any seizure activity.
3. School Nurse should always be notified of any seizure activity.
Sample 2: Care Plan
IV.
PROCEDURES
ESSENTIAL STEPS
1. Recognize signs of seizure activity and immediately
implement appropriate first aid:
a. Absence seizure
(1) Reassure, if needed.
(2) Repeat any missed information.
Brief lapses of consciousness (1-4 seconds, like
daydreaming) that begin and end abruptly.
b. Partial seizure
(1) Reassure and give emotional support as needed.
Consciousness unimpaired; uncontrollable
changes in mood, sensation, and/or movement
(such as twitching of a body party).
c. Complex Partial seizure
(1) Stay calm.
(2) Protect from harm and hazards:
(a) Direct away from hazards
(b) Do not grab roughly or restrain.
(c) Do not expect verbal instructions to
be obeyed.
Impaired consciousness accompanied by
confusion and uncontrollable automatic
movements (such as wandering about, touching
things, etc.).
May strike out if abruptly restrained. Lack of
responsiveness may be misinterpreted as a
behavior problem.
d. Generalized Tonic-Clonic seizure
(Grand Mal)
Loss of consciousness accompanied by falling,
stiffening and jerking movements (average time
is 1-3 minutes). Breathing is shallow or absent;
skin possibly pale or bluish.
(1) Remove nearby objects/hazards.
(2) Assist to a lying down position and turn to side,
ensuring open airway.
(3) Prevent head and neck injury:
(a) Place padding under head for protection.
(b) Remove eyeglasses.
(c) Loosen tight clothing around neck.
(4) Do not restrain and do not put anything in mouth.
(5) Remain next to student until consciousness is
regained.
(6) Call 911 if the following occurs:
(a) Seizure continues for more than 5 minutes.
(b) Breathing is absent after muscle jerks
subside.
(c) There is no known history of seizures or if
there is an increase in the severity of usual
seizure activity.
(d) Aspiration or injury occurs.
(7) Upon arousal, reassure student, reorient to
surroundings, and provide comfort measures as
needed.
(8) Allow a rest period, then encourage the student to
resume regular activities if he/she is able.
(9) Document seizure activity on the Seizure Record.
2.
3.
KEY POINTS & PRECAUTION
Stay with person until fully recovered.
Help re-orient to surroundings.
Restraining may cause further injury. Objects in
the mouth may cause obstruction or damage to
the oral structure.
Student may be awake but groggy.
Student may require clothing change due to
incontinence or emesis.
RESOURCES
GENERAL
American Academy of Neurology
651-695-1940
www.aan.com (provides valuable resources for medical specialists)
Charlie Foundation
1223 Wilshire Blvd.
Box 815
Santa Monica, CA 90403
800-367-5386 (Provides information and support for those on the
ketogenic diet)
Epilepsy.com
www.epilepsy.com (Information, videos, and on-line nursing and
medical support to answer questions)
Epilepsy Foundation
Los Angeles, Orange, San Bernardino, and Ventura Counties
800-564-0445
[email protected]
www.epilepsy-socalif.org (Excellent resource on all kinds of
information regarding seizures, includes teen programs and support
group information)
Epilepsy Foundation of America
800- EFA-1000
Information
800-EFA-4050
Library Database
301-459-3700
www.efa.org
National Institute of Neurological Disorders and Stroke
800-352-9424
301-496-5751
www.ninds.nih.gov (Provides information on epilepsy research)
OCTA Access
714-560-5956 (If eligibility requirements are meet the OCTA will
provide door to door transportation to medical appointments)
Vagus Nerve Stimulator Therapy Hotline
888-867-7846 (General information available)
888-508-8082 (Teleconference hosting a Case Manager and VNS
Therapy patient on Monday’s in Spanish at 1:00PM, Monday-Thursday
available at 8:00AM, 11:00AM, and 5:00PM in English. Call 888-5088082 prior to calling in to the teleconference to request the “Guide for
Patient Teleconferences”.
RELATED NEUROLOGICAL DISORDERS
The ARC (Formerly Association for Citizen with Retardation)
310-565-3842
www.thearc.org
Autism Society of America
301-657-0881
www.autism-society.org
United Cerebral Palsy
800-872-5827
www.ucpa.org
Tuberous Sclerosis Alliance
800-225-6872
www.tsalliance.org
SUPPORT GROUPS
ƒ Orange – COPE Group (with Epilepsy 101)
Alex Center, 165 N. Myrtle Avenue, Tustin, CA
Meetings are held the fourth Friday of every month, from 6:00PM
Facilitator: Staff of Epilepsy Foundation
ƒ Orange – Esperanza Spanish Group
CHOC West Building B, 455 South Main Street, Conference Room A,
Orange, CA
Meetings are held the first Friday of every month, from 7:00 to 8:30PM
Facilitators: Guadalupe Cabrera and Albert Sato (Volunteers)
ƒ Teen Programs are offered year-round though the Epilepsy Foundation.
Call 800-564-0445 or email [email protected] to get more
information.
ƒ Family Weekend Camp is held annually for families with children with
epilepsy. This is a great opportunity for families to learn more about
epilepsy, socialize, and enjoy recreational activities. For more
information call camp coordinator, Guadalupe Corral-Leyva, at 800-5650445.
ACCESS TO HEALTHCARE
CHOC Epilepsy Center – After Hours Care: 714-765-6618
After Hours Health Care Advice
KidWise: 714-633-2098
Information on Low Cost Health Insurance
MediCal/Healthy Families/California Kids: 714-289-4569
Clinica CHOC Para Ninos: Located in Santa Ana
Staffed with bilingual pediatricians, and nursing staff
Hours:
ƒ Monday-Friday 9am-6pm
ƒ Saturday 9am-3pm
ƒ Appointments: 714-558-8811
CHOC Clinic at Boys and Girls Club of Santa Ana
Full service clinic
Hours:
ƒ Monday and Friday 9am-5pm
ƒ Tuesday and Thursday 1pm-3pm
ƒ Appointments: 714-560-0494
CHOC Clinic at Costa Mesa
Staffed with bilingual pediatricians, and nursing staff
Hours:
ƒ Wednesday 9am-2pm
ƒ Thursday and Friday 1pm-6pm
ƒ Saturday 9am-2pm
ƒ Appointments: 949-722-9100
Healthy Tomorrows Mobile Health Clinic
Fully equipped medical van provides care within the community for students
and siblings
ƒ Call 714-532-7575 for appointments, locations, and schedules
Healthy Families
Why do children need
Healthy Families
insurance?
* To prevent serious
illness
* For regular health
check-ups
* To prevent emergency
room
Who is eligible for
Healthy Families
* Newborns up to age
of 19
* California residents or
U.S. citizens
* Children not currently
covered by health
care insurance
Documents required
to complete application:
The Healthy Families
medical program provides
comprehensive health, dental
and vision coverage.
Average cost: $4 - $27 per month
(depending on family income and size)
Unlimited doctor visits
Well baby check-ups
and immunizations
Prescription medications
* Proof of income
(two check stubs)
* Proof of income
deductions (child
support)
* Proof of immigration
status or copy of
birth certificate
Enroll now in Healthy Families!
For more information or to request
application assistance, please call:
(714) 289-4569
* Social Security Card
455 S. Main St., Orange, CA 92868
www.CHOC.org
Healthy Families
(Familias Saludables)
Por qué los niños deben
tener sequro médico?
* Para prevenir
enfermedades
* Para tenere exámenes
fisicos regularmente
* Para evitar visitas a la
Sala de Emergencias
El programa Healthy Families
medical le ofrece
asistencia médica, dental
y de visión a bajo costo.
Costo Promedio: $4 - $27
Quién es elegible para
Healthy Families?
* Niños recién nacidos
hasta los 19 anos de edad
* Residentes legales del
estado de California
(dependiendo del ingreso y tamaño de la familia)
Visitas al consultorio
de su doctor
* Ciudadanos americanos
* Niños sin plan de seguro
médico
Documentos necesarios
para llenar la solicitud:
* Comprobante de ingresos
de los padres (dos talones
de cheques más recientes)
* Prueba de deducciones
(comprobante de
manutención de niños)
* Acta de Nacimiento
(niño o niños) o tarjeta de
residencia legal de los niños
* Tarjeta de Seguro Social
Exámenes médicos
y vacunas para du bebé
Medicinas
Inscríbase hoy en Healthy Families!
Para más información, llame a:
(714) 289-4569
455 S. Main St., Orange, CA 92868
www.CHOC.org
Health
Services:
The fully equipped
medical clinics
are staffed
with bilingual
pediatric nurse
practitioners,
nurses and
assistants. Services
available for
children are:
■
Physical exams,
including school
entrance exams
■
Immunizations
Vision and
hearing screenings
■
■
CHOC HealthyTomorrows
Mobile HealthClinics
Well-child care
■
Sick visits
Follow-up
medical care with a
CHOC physician if
necessary
■
©2003 Children’s Hospital of
Orange County. All rights reserved.
Bringing bilingual medical care
to your Costa Mesa neighborhood
The CHOC Healthy Tomorrows Mobile Clinics:
■
Offer health care service and wellness education to children
■
Are committed to locating a medical home for Orange County’s uninsured and
underserved children. CHOC is a provider for government-sponsored programs including
CalOPTIMA, Healthy Families, California Children’s Services, California Kids and CHDP.
Healthy Tomorrows Schedule:
The CHOC Mobile Clinic is at an elementary school in your neighborhood or community.
We are at the following schools:
Rea School Every Wednesday • 8:30 a.m.– 4 p.m.
Whittier School Every other Monday beginning July 7th • 8:30 a.m.– 4 p.m.
Wilson School Every other Monday beginning July 14th • 8:30 a.m.– 4 p.m.
Please call (714) 532-7575 for an appointment and a location schedule.
CHOC Healthy Tomorrows Mobile Van Clinic
455 S. Main St., Orange, CA 92868 ■ (714) 532-7575 ■ (714) 532-7550 Fax
■
www.CHOC.org
Servicios
de Salud:
Las clínicas
médicas,
completamente
equipadas, cuentan
con enfermeras,
asistentes y
enfermeras
especializadas en
pediatría bilingües
Clínicas Móviles de Salud
“CHOC HealthyTomorrows”
Exámenes
Fisicos, incluyendo
los requeridos
para inscribirlos
en la escuela
■
■
Inmunizaciones
■
Exámenes de
la vista y de
la audición
■
Control de
niño sano
Consulta para
niños enfermos
■
Cita de
seguimiento
con un médico
de CHOC, si
es necesario
■
©2003 Children’s Hospital
of Orange County. Todos
los derechos reservados.
Llevando servicios médicos a su comunidad
en Costa Mesa por personal bilingüe
Las Clínicas Móviles “CHOC Healthy Tomorrows”:
■
■
Ofrecen los servicios de cuidados de la salud y educación para el bienestar de los niños.
Se han comprometido en ofrecer servicios médicos a los niños de bajos recursos del
Condado de Orange que no cuentan con seguro médico. CHOC es un proveedor de
programas patrocinados por el gobierno incluyendo CalOPTIMA, Healthy Families, California
Children’s Services, California Kids y CHDP.
Horario de Healthy Tomorrows:
Las Clínicas Móviles CHOC proveen servicios en las Escuelas Primarias de su comunidad.
Nos puede localizar en las siguientes escuelas:
Rea School Every Wednesday • 8:30 a.m.– 4 p.m.
Whittier School Every other Monday beginning July 7th • 8:30 a.m.– 4 p.m.
Wilson School Every other Monday beginning July 14th • 8:30 a.m.– 4 p.m.
Por favor llame al (714) 532-7575 para hacer una cita
y/o informarse sobre el horario de servicios.
CHOC Healthy Tomorrows Mobile Van Clinic
455 S. Main St., Orange, CA 92868 ■ (714) 532-7575 ■ (714) 532-7550 Fax
■
www.CHOC.org
REFERENCES
Devinsky, O. (2002). Epilepsy: Patient & Family Guide (2nd ed.).
Philadelphia: F. A. Davis Company.
Freeman, J. M., Vining, E. P. G., & Pillas, D. J., (2002). Seizures and
Epilepsy in Childhood A Guide (3rd ed.). Baltimore: The John Hopkins
University Press.
Hickey, J. V. (1997). The Clinical Practice of Neurological &
Neurosurgical Nursing (4th ed.). (pp. 53-56). Philadelphia: J. B. Lippincott.
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